Adults With Incapacity Symposium Flashcards
We must never assume in dentistry, what does this mean?
- everybody treated equally
- everyone assumed to have capacity unless proven otherwise
what age in scotland are people deemed to have capacity?
Age 16 years old
- you can make legally binding decisions for yourself
what is the adults with incapacity act?
Framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental illness, learning disability or a related condition or inability to communicate
who does the adults with incapacity act aim to protect?
People who lack capacity to make particular decisions, also to support their involvement in making decisions about their own lives
When does the adults with incapacity act (Scotland) come into action?
where an adult is incapable of making a decision for themselves
What part of the Adults with Incapacity act covers medical (including dental) treatment?
Part 5
Why is capacity important?
- capacity is key to autonomy (decision making)
- everyone has the right to say what happens to their own body
- everyone has the right to say what they dont want to happen to their own body
- competent adults have the right to refuse treatment
what is the legal definition of incapacity?
Inability of an adult to enter into legally binding contracts
- adult means person 16 & over
- an adult with a condition that they cannot understand what a decision involves
how do we assess capacity?
- always presume capacity
- is it ‘decision’ or ‘action’ specific
- capacity may fluctuate (not all or nothing)
- consider residual capacity
- record your assessment
- gather evidence from a range of sources & listen carefully to what the patient is telling you
what is meant by the statement: incapacity is not an “all or nothing” event?
Capacity can fluctuate throughout the day and course of disease etc.
what is residual capacity?
capacity of someone to make simple decisions
When making your assessment of capacity, what is important?
- keep language appropriate
- break up information into sections (chunk)
- ask the patient to explain back to you what you have discussed
- assess retention (ask patient at another appointment)
- seek advice when needed
- be open minded & methodical
An adult does not have impaired simply because…:
- they are in care
- they have a mental health condition
- they have difficulty with speech or writing
- they have addiction issues
- they have a brain injury
ETC.
Who may not have capacity?
If a patient has a “mental disorder”
- mental illness, learning disability, dementia, acquired brain injury, autistic spectrum disorder
If a person cannot communicate due to a physical disorder
- locket in syndrome, unconscious following an accident
What are the 5 aspects of being incapacitated?
- Acting
- Making a decision
- Communicating decision
- Understanding decision
- Retaining the memory of decision
AMCUR
what does AMCUR stand for?
- Acting
- Making a decision
- Communicating decision
- Understanding decision
- Retaining the memory of decision
How can difficult communication be aided within the dental practise?
- find out how a person communicates
- ensure a quiet, will lit environment
- allow adequate time
- use technology
- consider communication adjuncts
what are examples of technology that can help maximise communication?
- loop systems
- spelling boards
- ipads
To demonstrate capacity individual should be able to:
- understand in simple language what the treatment is, its purpose and nature & why its being proposed
- understand its principle benefits, risks & alternatives
- understand in broad terms what will be the consequences of not receiving the proposed treatment
- retain the information long enough
What are the 5 key principles of the AWI act?
- benefit
- minimum necessary intervention
- take account of the wishes of the adult
- consultation with relevant others
- encourage the adult to exercise ‘residual capacity’
What is meant by “benefitting” the patient under the AWI act?
- treatment must benefit the patient
- without treatment that benefit would not ve possible
- any intervention must improve or enhance their life
Any action or decision taken should be…:
The minimum necessary to achieve the purpose
- option that restricts the persons freedoms as little as possible
- always seek to avoid the most invasive treatment if simpler alternatives are available
If we are trying to take account of the wishes of the adult (present & past), how can this be done?
- any relatives or close friends who can help us find out?
- ask the patient
- look for a patients previous medical/care home notes
- is their mouth heavily restored? previous investment in dental treatment?
Who should we consult in relation to the patient with incapacity’s care?
- nearest relative & primary carer of the adult
- any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention
- any person whom the sheriff decides
- any other person appearing to the person responsible for authorising the intervention
why should we encourage residual capacity when making decisions?
- must identify if there are any decisions which the patient can make for themselves
- encourage the adult to exercise whatever skills they have concerning property, financial affairs or personal welfare
what is meant by Proxy?
A suitable adult substitute decision maker for someone without capacity?
Examples of Proxy?
- power of attorney
- guardianship orders
what are the types of power of attorney?
- continuing power of attorney
- welfare power of attorney
- combined power of attorney
what are the types of guardianship orders?
- welfare guardian
- financial guardian
what is power of attorney?
- POA is granted while a patient has capacity for someone to act on their behalf should the need arise
- powers are dormant until needed
- no expiry date
how is power of attorney set up?
- via a lawyer & does not need to go to court
- ## registered with the Office of the Public Guardian (OPG)
what does Continuing Power of Attorney cover?
Financial affairs and property
- CANNOT CONSENT TO DENTAL TREATMENT
what does welfare power of attorney cover?
Welfare decisions including healthcare, dressing, eating etc.
- only come into affect if adult loses capacity
- must take into account adults wishes
- CAN CONSENT TO DENTAL TREATMENT
what does combined power of attorney cover?
Welfare & financial decisions
- CAN CONSENT TO DENTAL TREATMENT
What is the only type of POA that cannot consent dental treatment?
Continuing power of attorney
who decides on guardianship orders?
Court appointed person to make decisions on behalf of an adult with incapacity
- appointed by sheriff after the adult has lost capacity
What do guardianship orders require?
2 medical reports
What do guardianship orders cover?
Continuous management of welfare & financial matters
- power to deal with property, finance & even marital affairs
How long are guardianship orders valid for?
3 years
Who can consent for dental treatment?
- patients with capacity
- welfare powers of attorney
- welfare guardians
- Medical & Dental practitioners under section 46 of AWI Act (general authority to treat)
If a relative who does not possess welfare powers of attorney or welfare guardian powers, can they consent on behalf of another adult?
NOOO
Who can issue certificates of incapacity?
- medical practitioner primarily responsible for the patients care
- consultant in charge of patients care
- dental practitioners *
- registered nurses *
- optometrists *
Can dentists automatically give consent under the general authority to treat?
Must do a short course & fill out certificate (Section 47 form) in order to be able to do this
If a dentist issues a certificate of incapacity, what treatment does that cover?
Dental treatment ONLY
Is a general dental practitioner able to sign the section 47 form?
Unlikely!
- required to liaise with GMP
- GMP should assess capacity of the patient
- If satisfied of incapacity GMP should provide you with an adults with incapacity form
- provide GMP with details to avoid inappropriate generalisation
